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States Consider Mandating HPV Vaccine

The vaccine Gardisil, produced by Merck to prevent certain strains of the human papilloma virus (HPV) that cause cervical cancer, recently became mandated in Texas, and could become mandatory for school-aged girls around the country. At least 11 states, including California, Colorado, Illinois, Indiana, Kentucky, Ohio, West Virginia, Virginia, South Carolina, and Maryland, as well as the District of Columbia are considering legislation on this issue. The vaccine, which was approved by the Food and Drug Administration in June after thorough testing for efficacy and safety, has been praised as being capable of saving thousands of women’s lives by preventing the leading cause of cervical cancer.1

Gardasil is administered by three injections over six months at a total price of $360. According to Merck, the vaccine has shown 100% effectiveness in clinical trials, providing protection from the HPV strains (16 and 18) that cause 70% of cervical cancer.2 Because HPV is easily transmitted through sexual contact, near-universal vaccination of girls and young women prior to sexual activity is being considered as a way of reducing overall incidence of cervical cancer.

Roughly 20 million people are currently infected with HPV, and there are about 6.2 million new infections every year. Most individuals who become infected with the virus will remain asymptomatic while some will develop genital warts. HPV infections generally clear on their own. In some cases, however, the virus causes the cells on the cervix to change which can lead to cancer. HPV has been found to cause cancer in approximately 10,000 women in the U.S. resulting in about 3,700 a year, according to the American Cancer Society.3

In June 2006, the Center for Disease Control’s Advisory Committee on Immunization Practices (ACIP) voted unanimously to recommend that girls and women ages 11–26 receive the HPV vaccine. ACIP recommendations generally become the standard of practice for health-care professionals around the country. These standards determine whether public and private insurers will reimburse for the vaccine.4

States are now considering whether to make this vaccine mandatory for public school students. In California, for example, Assemblywoman Sally Lieber (D-Mountain View) introduced California Assembly Bill16 (CA A.B. 16) which would require girls to be immunized against HPV before they enter the 6th grade.5 The bill allows parents to “opt out” if they have an objection to the vaccination, nonetheless the introduction of the legislation has shed light on several of the controversies around mandating the vaccine.

Some parents are concerned that mandatory vaccination will force them to have frank discussions about sex. Mark Mangin, a parent from San Jose says, “It’s very complicated, you don’t explain anything to your kid when they get a measles shot. The thing that crossed my mind is, what will the kids think? Will they think it’s OK to have sex if you get this vaccine?”6 Others raise concerns about schools and legislators getting involved in an issue that some think should remain between parents and doctors. In California, some argue that a better tactic for reducing HPV infection would be to launch a public information campaign. Lieber counters, “This is the first time we have a chance to prevent a virulent form of cancer, what we’re trying to do is prevent disease, not mandate morality.”7

Despite the controversy, proponents of mandatory vaccination feel that ensuring that school-aged girls have access to Gardisil is the best way protect the upcoming generation from this type of cancer. Nancy Clites, a mother in Texas said, “I’m all for anything we can do to help prevent cancer, it’s going to require an effort on the part of parents to educate their children when they get the vaccine.”8 Advocates also argue that the best way to expedite coverage from individual insurance providers would be for states to mandate the vaccine for young women.9